After suffering from hypertension, if you can't effectively control your blood pressure by restricting diet, losing weight, quitting smoking and drinking, and strengthening exercise, you need medication. Drugs are the most effective way to treat hypertension at present, and patients must take drugs in strict accordance with the doctor's advice.
The increase of blood pressure is a slow process, and the treatment of hypertension also needs to emphasize the smooth blood pressure reduction, so it should be slow rather than fast. Antihypertensive drugs are generally taken for a long time, and sometimes patients will take them for life. The ideal antihypertensive drug should be able to effectively lower blood pressure, and only once a day, with fewer side effects, and will not strengthen the role of other cardiovascular risk factors. The purpose of drug therapy is not only to lower blood pressure itself, but also to strengthen the protection of heart, brain, kidney and other organs. At present, the commonly used drugs are:
First-line drugs for hypertension
Diuretics, beta blockers
Calcium antagonist α receptor blocker
ACEI (angiotensin converting enzyme inhibitor)
Angiotensin Ⅱ receptor antagonist
Among the above drugs, ACEI (angiotensin converting enzyme inhibitor) and ARB (angiotensin ⅱ receptor antagonist) have protective effects on organs.
ACEI can moderately and persistently lower blood pressure, and at the same time, it has a good protective effect on target organs. Its representative drug Benazepril (Lotensin) has the characteristics of dual-channel excretion and is widely used in the treatment of hypertension. At the same time, because of its strong affinity to kidney tissue, it is also regarded as a renal protective drug; Recent research reports show that it can also significantly improve the prognosis of patients with heart failure.
ARB is a newly developed drug for treating hypertension, which is considered as a milestone of cardiovascular drugs in the 1990s. Studies have proved that these drugs are safe, effective and well tolerated, and have protective effects on heart, brain and kidney. It represents that valsartan (Dai Wen) can improve the common sexual dysfunction in patients with hypertension.
We should see more doctors in the treatment and prevention of hypertension. Doctors can help patients prevent and control high blood pressure. With the help of doctors, patients can give themselves a chance to prolong their lives and enjoy a healthy life.
In what range should blood pressure be controlled?
Once hypertension is diagnosed, blood pressure should be controlled within the normal range as much as possible. The blood pressure of mild patients should be controlled below 135/85mmHg, and that of elderly patients should be controlled below 140/90 mmHg. The systolic blood pressure of patients with simple systolic blood pressure increase should also be controlled below 65438±0.40 mmHg. Studies have shown that for every 5mmHg reduction in diastolic blood pressure, the mortality of patients will be significantly reduced by 32%, stroke by 44%, diabetic complications (including amputation) by 24%, and microvascular complications (including retinal hemorrhage) by 37%. Experts found that in the group with the lowest blood pressure, the incidence of cardiovascular events decreased significantly, and the rate of renal function decline was also the slowest. Therefore, it is best to set the blood pressure control target at 130/80mmHg.
The treatment of hypertension is lifelong. Even if the blood pressure is controlled within the ideal range, the antihypertensive treatment cannot be stopped, so as to prevent those potentially dangerous complications.
What are the three taboos to pay attention to when using antihypertensive drugs?
Long-term use of antihypertensive drugs should remember the following three taboos:
First, avoid taking too much to cause a sudden drop in blood pressure. Human arterial blood pressure is the driving force of blood flow to tissues and organs, which is of great significance to ensure the blood flow required by tissues and organs. For example, the blood pressure drops sharply, and the blood supply of tissues and organs in the whole body is insufficient, especially the important organs such as heart, brain, liver and kidney will be dysfunctional due to lack of oxygen, and even have adverse consequences.
Second, avoid the blood pressure rebound caused by sudden withdrawal. Hypertensive patients who take antihypertensive drugs for a long time, if they suddenly stop taking them, can make their blood pressure rebound and cause a series of reactions, which is clinically called antihypertensive drug withdrawal syndrome. Mainly manifested as a sudden increase in blood pressure, causing dizziness, headache, fatigue, sweating and a series of symptoms. Some patients may be life-threatening due to sudden increase of blood pressure complicated with cardiovascular spasm, myocardial infarction or cerebrovascular accident. This is because some antihypertensive drugs are taken for a long time, which makes the body dependent on them. Once the drugs are suddenly stopped, there is a rebound phenomenon. Therefore, patients who take antihypertensive drugs for a long time should not stop taking them suddenly, but should gradually reduce the dose, balance the transition and ensure safety.
Third, avoid taking medicine before going to bed to induce cerebrovascular accidents. The traditional way to take antihypertensive drugs is to take them three times a day. Some hypertensive patients are used to taking 1 time before going to bed, thinking that their blood pressure will drop after taking the medicine and they can sleep comfortably. As we all know, taking medicine before going to bed can reach the peak of blood concentration after 2 hours, and at this time, the human body's own blood pressure is also decreasing. The combination of the two can lead to a significant drop in blood pressure, thus inducing cerebral thrombosis, cerebrovascular accident, angina pectoris, myocardial infarction and so on. Therefore, patients with hypertension must take medicine according to the time ordered by doctors, or take medicine according to the principle of chronopharmacology to avoid the above adverse consequences caused by improper timing of taking medicine.
What are the adverse reactions of commonly used antihypertensive drugs?
Most hypertensive patients need to take antihypertensive drugs for life, so the adverse reactions of antihypertensive drugs are also highly valued by patients. Although most drugs are excreted by liver metabolism and kidney, it does not mean that they are harmful to liver and kidney. Patients can consider using dual-channel excretion drugs, such as Lotensin. All kinds of drugs have different adverse reactions. Due to the different reactivity of each patient, the manifestations of adverse reactions are also different. All kinds of antihypertensive drugs widely used now have been clinically verified for a long time, and the incidence of adverse reactions is low. As long as the patient's condition is comprehensively analyzed and drugs are used reasonably, adverse reactions can be avoided.
1) Diuretics: Adverse reactions include hypokalemia, hyperuricemia, hypercalcemia, hyperglycemia and hyperlipidemia. In addition, it will also have adverse effects on patients with renal insufficiency.
2) Beta blockers: bradycardia, induced bronchial asthma, hyperglycemia, hyperlipidemia, etc. Although it has recently been found that low dose can treat some heart failure, high dose can cause acute heart failure.
3) Calcium antagonist: Nifedipine can produce facial flushing, headache, increased heart rate and ankle edema. Verapamil and diltiazem are not used in patients with bradycardia and atrioventricular block because they inhibit cardiac conduction and sinus node function.
4) Alpha blockers: Postural hypotension, especially when taking the first dose, is easy to occur. Therefore, the first dose is often taken before going to bed, and attention should be paid to avoiding getting up at night.
ACEI: The most common symptoms are itchy throat and dry cough.
6) Angiotensin Ⅱ receptor antagonist (ARB): No obvious adverse reactions have been found so far.
Contraindications in the use or compatibility of antihypertensive drugs
Potassium-sparing diuretics are prohibited from being used together with angiotensin converting enzyme inhibitors.
Beta blockers are prohibited in patients with heart failure.
Angiotensin converting enzyme inhibitors are prohibited for pregnant women.
Calcium channel blockers and diuretics are not a good combination, but the combination of angiotensin converting enzyme inhibitors is suitable for diabetic nephropathy.
The combination of angiotensin converting enzyme inhibitor and potassium-preserving diuretic can prevent hypokalemia.
Beta blockers should not be combined with diuretics for a long time, because they can cause blood sugar and blood lipid disorders.
New concept of drug therapy for hypertension
The choice of drugs to treat hypertension has changed from safely and effectively lowering blood pressure to following the following principles:
1. Reduce blood pressure safely and effectively;
2. Conducive to improving metabolic disorder;
3. Protect the target organs from damage and effectively reduce the incidence of hypertension complications;
4. It is suitable to cooperate with the treatment of other systemic diseases to reduce the occurrence of adverse reactions.
How do the elderly use antihypertensive drugs?
Hypertension is a common disease in the elderly. Non-drug therapy should be the first choice for mild patients, including weight loss, limiting sodium intake, increasing exercise, limiting alcohol consumption, quitting smoking and relaxation therapy. Moderate or severe patients should take drug therapy combined with non-drug therapy, and should pay attention to the following issues:
1. It is better to choose invertase inhibitors (such as Lotensin), calcium antagonists (such as nifedipine) and diuretics (such as hydrochlorothiazide). 2. Appropriate antihypertensive drugs should be selected as the first-line drugs, starting from a small dose and gradually increasing the dose. When blood pressure can't be controlled, switch to another drug or combination drug. When a variety of antihypertensive drugs with different modes of action are combined, hypertension can often be controlled in small doses with little side effects.
3, antihypertensive drugs usually need to be taken for a long time, blood pressure should be measured regularly, and the dose should be adjusted according to the symptoms and blood pressure level. 4. After the drug has some side effects, the dosage can be adjusted according to the degree of reaction.
5. Blood pressure should not be too low. Patients with hypertension should move slowly when their postures change, such as sitting up and standing, and should not take part in more strenuous exercise.
How to treat hypertension with renal damage
To treat patients with hypertensive renal damage, it is necessary to actively control blood pressure to delay the process of renal damage, pay attention to renal function when taking drugs, and choose drugs that protect renal function as much as possible. Angiotensin converting enzyme inhibitors (such as Lotensin) and diuretics should be the first choice for hypertensive patients with mild renal damage, because the former has the function of protecting renal function. In order to avoid hyperkalemia caused by excessive blood pressure reduction, they should start taking small doses. When using diuretics, excessive diuresis is not advisable, so as not to cause insufficient blood volume and electrolyte disorder.
Patients with hypertensive renal damage should also pay attention to a low-salt, high-quality and high-protein diet and avoid using drugs that are toxic to the kidney, such as aminoglycoside antibiotics streptomycin and gentamicin.
Kidney is one of the main target organs of hypertension damage, and it is also an important organ for regulating blood pressure. If hypertension damages the kidney, it will aggravate the severity of hypertension because the kidney regulates the metabolic disorder such as body fluid balance and vasoactive substances. In various primary or secondary renal parenchymal diseases, including glomerulonephritis, diabetic nephropathy, obstructive nephropathy, etc. Hypertension can reach 80 ~ 90%.
How should hypertensive patients take it with other drugs?
A considerable number of hypertensive patients are elderly people. Besides hypertension, they often suffer from other chronic diseases at the same time. Besides taking antihypertensive drugs, they have to take other drugs. In this way, it will inevitably involve the problem of rational drug use. So, have you ever thought about the interaction between various drugs? Does this interaction have any effect on the body? Which drugs are safer to take at the same time? The interactions between several commonly used drugs are briefly described as follows:
The most common situation is that some patients with hypertension have left ventricular hypertrophy or even cardiac function damage over time, and eventually lead to heart failure because they are not found in time or pay attention to treatment or irregular medication. In order to control heart failure, digitalis cardiotonic drugs and antihypertensive drugs are often taken. In the long-term clinical work, medical workers found some calcium antagonists, such as nifedipine, nitrendipine, verapamil, diltiazem and so on. It can increase the concentration of digitalis drugs in blood and may cause digitalis poisoning. Especially for patients with renal function injury, the interaction between nitrendipine and digitalis preparation will also affect the antihypertensive effect of the former.
In addition, some calcium antagonists combined with β -blockers can cause obvious hypotension, and the combination of diltiazem and β -blockers may have adverse effects on heart rate, atrioventricular conduction and left ventricular function. Verapamil combined with quinidine, an antiarrhythmic drug, not only causes hypotension, but also increases the blood concentration of quinidine, resulting in adverse consequences. Therefore, patients with hypertension must pay attention. To prevent the continuous development of kidney disease.
The treatment of mild hypertension can not be ignored.
For patients with hypertension diagnosed (systolic blood pressure higher than 140mmHg and diastolic blood pressure higher than 90mmHg), continuous treatment including drug use should be taken, and no one has any objection. Medical scientists have confirmed through years of research that the consequences of treatment and non-treatment of hypertensive patients are completely different. After systematic treatment, patients can delay the progress of the disease and reduce the occurrence of serious complications such as cerebral hemorrhage, heart failure and renal failure caused by hypertension. However, for a long time, people's understanding of whether patients whose blood pressure exceeds the normal standard and their symptoms are not serious need treatment is still inconsistent.
The so-called "not too serious" hypertension means that the diastolic pressure is 90 ~ 104 mmhg, and there is no organ damage caused by hypertension. According to statistics, patients with hypertension account for about 70% of the total number of people with hypertension at this stage, and the existence of these patients has become an important public health problem.
Studies have shown that after planned and systematic treatment, the complications and mortality of hypertensive patients with diastolic blood pressure higher than 1 15mmHg before treatment are much lower than those of untreated patients. It also has a very significant therapeutic effect on patients with diastolic blood pressure of 90 ~ 1 14 mmHg, which shows that the number of cerebral hemorrhage, death and the number of people who develop into acute hypertension, left heart failure and renal insufficiency are reduced, and the blood pressure can remain stable for many years, and it is not easy to cause left ventricular hypertrophy or heart failure.
Therefore, at present, patients with diastolic blood pressure higher than 105mmHg must receive antihypertensive drugs, while patients with diastolic blood pressure between 90 ~ 104 mmHg should decide the treatment plan according to the specific condition.